Pharmacies, not doctors, biggest source of pain pills

Reining in doctors won't end pill mill problem, critics say

April 10, 2011|By Bob LaMendola, Sun Sentinel

Florida cannot throttle rampant illegal traffic in pain pills by banning doctors from selling narcotic drugs, as Gov. Rick Scott and some state legislators propose. That's because doctors sell only a fraction of the pills.

So says a Nova Southeastern University researcher who calculates that doctors and pain clinics dispense an estimated 16 percent of the state's supply of oxycodone — the favorite drug at pill mills. About 80 percent of the pills are sold at pharmacies.

Dealers and addicts get most of their pain pills by "doctor shopping," a practice of visiting multiple doctors and drugstores to amass large quantities, police say. Banning doctors from selling pills would not slow doctor shopping, said Jim Hall, director of NSU's Center for the Study & Prevention of Substance Abuse.

"Banning the doctors … would do something, but it wouldn't do that much good," said Hall, who analyzed 2009 figures from the Drug Enforcement Administration.

The NSU research fuels a heated debate in the Legislature about how to combat Florida's role as the biggest single supplier in the Southeast of illegal pain pills, especially from unscrupulous pain clinics.

State officials are sharply divided. Attorney General Pam Bondi and Senate leaders favor starting the state's planned computer database to log all pain-drug prescriptions, so doctors, pharmacists and police can detect doctor shoppers. The stalled project got a boost Friday and could be ready to operate in three or four months.

But the governor and lawmakers in the House are pushing bills to kill the database, calling it ineffective and an unnecessary government intrusion on patient privacy. Instead, they favor the ban on doctors dispensing painkillers, anti-anxiety drugs and other controlled substances.

Florida has more than 6,300 "dispensing practitioners," who pay $100 a year for a license to sell medicine. That's almost double the 3,700 licensed in 2008, state figures show.

The growth of dispensing doctors tracks the boom in pain clinics. With dispensing doctors on staff, rogue clinic operators have made millions prescribing and selling pills. The number of pain clinics grew from almost none in 2007 to a peak of 1,300 last year. The number has fallen to about 860 since officials began cracking down. Before the pill mill boom, doctors sold less than 3 percent of oxycodone.

Nationally, only four states restrict doctors from selling drugs. In Florida, doctors have opposed the ban and defend their right to sell drugs from their offices, saying it helps severely injured and sick patients who can't travel. Also, doctors who custom-mix pain medicines would have to stop.

"Some patients really need this," said Dr. Jeffrey A. Zipper, a dispensing doctor and chief executive at the National Pain Institute, a chain based in Delray Beach with three clinics in Orange and Seminole counties.

The state has cut off most pain clinic sales by limiting them to sell only three days' worth of pills per month, meaning patients must go to drugstores for the rest.

"If a ban on physician dispensing would cure the problem, I believe the medical community would be behind it. But it doesn't cure the problem," Zipper said.

House Speaker Dean Cannon, R-Winter Park, a leading advocate of banning doctor dispensing, acknowledges that many doctor shoppers buy their supply at pharmacies, his spokeswoman said.

That's why House leaders added to their bill (HB 7095) restrictions saying narcotic pills could only be sold by pharmacies owned by publicly traded corporations, companies with $100 million in Florida assets and those open for at least 10 years. The bill also would repeal restrictions passed last year, such a ban on convicted felons owning pain clinics and regular state inspections.

The pharmacy restriction would halt pill mills from opening pharmacies or teaming up with small drugstores to skirt the state's restrictions on pain clinics, Cannon spokeswoman Katie Betta said.

"We have proposed what we would consider reasonable limitations for pharmacies to continue dispensing controlled substances," Betta said.

Small pharmacies have protested loudly, saying the restriction would unfairly hurt about 800 stores and boost giant companies.

"This would punish the independents and the privately owned companies," said David B. Brushwood, a University of Florida pharmacy professor.

Betta said House leaders are open to negotiating with opponents to find a compromise and pass a pill mill bill before the legislative session ends May 6. The pain pill database is "certainly part of the conversation," she said, but Cannon wants assurances it can be kept secure to protect patient privacy.

"If we are going to address this problem this year, we are going to have to come to a consensus," Betta said. "We're open to working with the governor's office, the attorney general and the Senate. It's too soon to tell what will happen."